OP RHTE# /3 -s7 "569Z Harnett County Department of Public Health 23323
PERMIT # Z°7"7y0 Operation Permit /
New Installation Cr
Septic Tank Er /Nitrification Line ❑ Repair ❑ Expansion
PROPERTY LOCATION: jx iy37 ,e6
Name: (owner) /3.r,�- Ie, f�yA SUBDIVISION ,, ® LOT # —7
System Installer: -Sim /$v� =! Registration #
Basement with plumbing: ❑ Garage Number of Bedrooms .S
Type of Water Supply: ❑ Community Public ❑ Well Distance from well feet
System Type: `v r fiG., IE G— Types V and VI Systems expire in 5 years.
(In accordance with Table V a) Owner must Antact Health Department 6 months prior to expiration for permit renewal.
This system has been installed in compliance with anolicable North Carolina penAl StatuteciRules for Sewage Treatment and Disoosal. and all conditiorf of the
jvwo,.._
PERMIT CONDITIONS:
I. Performance: System shall perform in accordance with Rule .1961.
II. Monitoring: As required by Rule .1961.
Ill. Maintenance: As required by Rule .1961. Other:
Subsurface system operator required? Yes ❑ No ❑
If yes, see attached sheet for additional operation conditions, maintenance and reporting.
IV. Operation:
V. Other:
Permit and Construction Authorization.
❑ D -Box ❑ Pump ❑ Alarm ❑ H2OLine ❑ PWR Line
Following are the specifications for the sewn a disposal system on the above captioned property.
Type of system: ❑ Conventional Z Other ISM> '�® Septic Tank: /aDv gallons Pump Tank: gallons
Subsurface No. of exact length width of depth of
Drainage Field ditches y of each ditch % feet ditches 3 feet ditches _Zq inches
French Drain Required: Linear feet
Authorized State Date & - W —14
13- 5- 32308R (2) 13- 5- 32308R (3) 13- 5- 32308R (4) 13- 5- 32308R (5) 13- 5- 32308R (6)
13- 5- 32308R (1)